THE EUSTACHIAN TUBE 311 of a grommet in the drumhead will give some symptomatic relief. Insuffla- tion of an irritant powder, consisting of four parts of boric acid and one part of salicylic acid, into the Eustachian tube was formerly recommended as a means of obtaining temporary relief. EUSTACHIAN TUBAL FOREIGN BODIES The use of bougies for dilatation of the Eustachian tube accounted on some occasions for a foreign body consisting of a part of the bougie which had accidentally broken off and become lodged in the cartilaginous part of the tube. Small foreign bodies perforating the tympanic membrane may pass into the Eustachian tube and become lodged in the bony portion or at the isthmus. Foreign bodies should be removed from the tube as soon as possible. A surgical approach by a combined postauricular and transmeatal route to the bony Eustachian tube has been described. OTITIC BAROTRAUMA (AERO-OTITIS MEDIA) Otitic barotrauma is related to the condition and patency of the Eustachian tube in its function of ventilating the middle ear so that atmospheric pressure pertains on both sides of the drumhead. Barotrauma follows rapid descent in an aeroplane or, in high-speed aircraft, a very fast ascent. It may occur in the presence of tubal dysfunction involving its patency and preventing adequate ventilation of the middle ear in a situation which often arises suddenly. Swallowing and yawning cause contraction of the tensor and levator palati muscles which open the Eustachian tube thus allowing equal- ization of pressure in the middle ear. Chewing of sweets or gum may there- fore be advised as a preventive measure during descent. For those who have previously suffered from the condition a decongestant nasal spray or a benzedrine inhaler is a useful prophylactic measure. The symptoms of baro- trauma vary from slight discomfort and feeling of fullness in the ear to acute pain with effusion and deafness. Deafness and tinnitus may persist after landing and inspection of the drumhead may show gross retraction and congestion. Equalization of pressure is necessary at the earliest moment. During descent the intermittent performance of Valsalva's manoeuvre may be useful and later catheterization and inflation are often necessary. Many cases settle spontaneously or with the help of conservative measures but in a few cases myringotomy and aspiration of the effusion are necessary. In the presence of an acute upper respiratory infection the risk of a suppura- tive otitis media is increased and a prophylactic course of an antibiotic such as penicillin is justifiable. In the majority of patients return of normal func- tion may be expected.